Aug 27, 2020, By: Donna M. Wilson, Carolina F. S. Benedetti, Jean A. C. Triscott
This article is among the first on Canadian Nurse to focus on the issue of racism — particularly anti-Black racism — in nursing and health care. Our aim is to give a voice to those who have experienced racism or want to speak out against it.
- Culture — which includes customary beliefs, traits, and behaviours — affects health and the delivery of health-care services.
- All nurses and physicians need to be prepared for and respectful of the cultural differences that are likely to exist among their patients and co-workers.
- While nursing and medical education programs are helping to ensure that every student has at least introductory knowledge of multiculturalism, the diversity in content, teaching methods, and evaluation methods is concerning.
With multiculturalism a major feature of modern society, Canadian nurses and doctors must be prepared more than ever for cultural differences among their patients and co-workers. The 2016 census showed 21.9% of Canadian residents are immigrants, the highest level since 1921; by 2036, it is estimated that 30% of citizens will have been born outside Canada (Statistics Canada, 2020).
Not only is Canada increasingly populated by immigrants, but cultural diversity is also on the rise. Most new immigrants to Canada are coming from Asia (primarily the Philippines, India, and China); Africans are the next most common immigrant group (Statistics Canada, 2020).
Currently, 22 languages other than English or French are spoken in Canada by more than 100,000 people each (Statistics Canada, 2020).
Language and cultural differences are important to anticipate in the workplace because these affect health, health-care decisions, health-care decision-making, and also social practices. Culture is often defined as the customary beliefs, traits, and behaviours of racial, ethnic, religious, and social groups.
Although it may be a function of the family and the K–12 education system to prepare children in Canada for multiculturalism, it cannot be assumed that all nursing and medical students will have gained the needed insights and information about multiculturalism to be able to function effectively as health-care professionals. To that end, an online survey of all nursing and medical schools in Canadian universities was conducted over 2018–19 to gain information on if, when, what, and how their undergraduate students learn about “culture” or “multiculturalism.”
Not only is Canada increasingly populated by immigrants, but cultural diversity is also on the rise.
One representative at each school was asked to answer seven questions:
- Are your students taught about “culture” or “multiculturalism”?
- If so, in what years are they taught it?
- If so, what specific content is covered?
- If so, how are they taught?
- If so, is knowledge about multiculturalism and/or respect for cultural diversity encouraged in ways other than lectures?
- If so, are student multicultural knowledge and competencies tested or evaluated?
- Is multiculturalism otherwise addressed or enhanced at your school?
Although we did not get information back from every school, the majority responded, including nursing and medical schools in every province that has them. All reported that they routinely teach multiculturalism to their undergraduate students. We also learned that this content is most often provided in two or more years, and through a number of teaching methods.
The most common method is to include multicultural content in existing courses, with students getting one or more lectures on various multicultural topics. Three other relatively common teaching methods are to require students to write a paper on a multicultural topic, for students to take part in a planned cultural group encounter, and for students to have a clinical practicum somewhere in Canada where exposure to different cultural groups is expected.
It was exciting to learn that a wide variety of topics are covered. The most common are the significance of multiculturalism, respecting people of different cultures, specific information about common cultural groups, the impacts of discrimination, what discrimination is, facts and figures about multiculturalism, what needs to be done to stop discrimination, what needs to be done to prevent discrimination, how to communicate with people who speak a different language, and the Canadian Charter of Rights and Freedoms.
We found student learning was routinely evaluated. Most often this was achieved by adding some test questions to a larger exam. Nearly half of the schools had students write a specific test on multiculturalism, and almost all said they expect students to be able to demonstrate satisfactory clinical performance.
It was also encouraging to learn that all schools did other things that demonstrate their awareness of a multicultural Canada, such as by encouraging Indigenous students to apply. Most also encourage immigrants to apply to attend the program at their school. In addition, most reported having multicultural continuing education for their teachers and having teachers who represent visible minority groups.
This is an important time for nurses and physicians to lead the way in ensuring that culturally safe workplaces and care settings exist for patients and staff.
Clearly, at this time, Canadian nursing and medical schools have recognized the need for nurses and physicians to be prepared for and respectful of patients and co-workers who differ in culture, ethnicity, race and religion. Nursing and medical programs are helping to ensure that every student has at least introductory cultural sensitivity and a basic knowledge of multiculturalism.
However, the diversity in content, teaching methods, and evaluation methods across the schools is concerning. Some schools clearly place more emphasis on multiculturalism than others. Hopefully in the future, curriculum standardization will occur. Active learning should also increase, as this is the most likely way to influence student attitudes and behaviours. Examples of this type of learning include having visitors come to classes to share personal experiences of racism and discrimination; being paired with a new immigrant family for a term to help them adjust to life in Canada; and ensuring students, during their clinical practicums, have the opportunity to care for people who are culturally different from them.
Canada is in a state of transition, with rapidly increasing cultural diversity. This is an important time for nurses and physicians to lead the way in ensuring that culturally safe workplaces and care settings exist for patients and staff. We have a choice now to continue to embrace the intended ideals of Canada as a multicultural mosaic, or ignore this social tsunami and bear the consequences of it.
Canadian nursing organizations in particular need to take notice, as there were only 37,370 internationally educated nurses licensed to practice in Canada in 2019; 8.9% of Canada’s regulated nurses (Canadian Institute for Health Information, 2016-2020). This low figure compares starkly against the census finding that showed 21.9% of Canadian residents are immigrants (Statistics Canada, 2020). It also stands in contrast to the fact that 26.4% of physicians working across Canada in 2018 received their MD degree in another country (Canadian Institute for Health Information, 2019).
The information gained from this survey is highly relevant for Canadian nursing and medical schools, other health-care organizations, and practicing nurses and doctors to use.
Although established now in nursing and medical schools, multiculturalism would benefit from additional thought and curricular development across Canada. All nurses and physicians need to be prepared for and respectful of the cultural differences that are likely to exist among their patients and co-workers. Thankfully, nursing and medical schools in Canada are working toward that aim. The question now is: What else can each of us practicing nurses do?
Canadian Institute for Health Information. (2016-2020). Nursing in Canada, 2019.
Canadian Institute for Health Information. (2019). Physicians in Canada, 2018. Summary report.
Statistics Canada. (2020). Immigration and ethnocultural diversity in Canada.
This study was funded by Covenant Health, a Catholic organization in Alberta. This paper also acknowledges the General Assembly of the United Nations for declaring May 21 as the annual World Day for Cultural Diversity for Dialogue and Development. The first observance was in 2003, after the United Nations designated 2002 as the Year for Cultural Heritage.
Donna M. Wilson, PhD, RN, is a professor in the Faculty of Nursing at the University of Alberta, Edmonton. She is also an adjunct professor in the Faculty of Education and Health Sciences, University of Limerick, Ireland; and co-director of the University of Alberta’s Centre for Health and Culture. She can be reached by email at: firstname.lastname@example.org
Carolina F. S. Benedetti, BSN, RN, Federal University of São Paulo Intern, São Paulo, Brazil. Carolina spent one term during her undergraduate nursing program in Brazil as an exchange student at the University of Alberta. She has since graduated and works as an organ transplant nurse in Brazil.
Jean A. C. Triscott, BED/AD, MD, CCFP(COE), FAAFP, FCFP, is a professor and director of the Division of Care of the Elderly, Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton.